MEDICARE: MRS. SHAWNA DORMAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	254758	NY
2	207L00000X	Anesthesiology Physician	149964	CA

General Provider Information

NPI Number	:	1912171224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHAWNA DORMAN MD

Provider Business Mailing Address
First Line	:	6801 PARK TER STE 300
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-9212
Country	:	US
Telephone Number	:	857-523-0002
Fax Number	:

Provider Business Practice Location Address
First Line	:	6801 PARK TER STE 300
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-9212
Country	:	US
Telephone Number	:	857-523-0002
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2008
Last Update Date	:	12/08/2021

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